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Parasitic infections rarely involve the oral and maxillofacial regions and pose a diagnostic challenge when they do. Hydatid cysts are parasitic cysts caused by Echinococcus granulosus. Intraosseous involvement is observed in 3% of cases, of which only 2-6% are in the maxillofacial region. A scientific literature search revealed only seven cases involving the mandible. We report a rare case in a 16-year-old female patient who presented with facial asymmetry and well-defined radiolucency of the ramus. Our findings will help in understanding the diagnostic issues caused by non-specific presentation and difficulties in suspecting such a rare diagnosis as echinococcosis of the oral or maxillofacial region. A thorough systemic investigation is essential as 20-30% of these cases show multiorgan involvement.

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ABSTRACT Parasitic infections rarely involve the oral and maxillofacial regions and pose a diagnostic challenge when they do. Hydatid cysts are parasitic cysts caused by Echinococcus granulosus. Intraosseous involvement is observed in 3% of cases, of which only 2-6% are in the maxillofacial region. A scientific literature search revealed only seven cases involving the mandible. We report a rare case in a 16-year-old female patient who presented with facial asymmetry and well-defined radiolucency of the ramus. Our findings will help in understanding the diagnostic issues caused by non-specific presentation and difficulties in suspecting such a rare diagnosis as echinococcosis of the oral or maxillofacial region. A thorough systemic investigation is essential as 20-30% of these cases show multiorgan involvement.

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Echinococcus granulosus infection is the primary cause of spinal hydatidosis. We describe the case of a 22-year-old man from the Brazilian Amazon region with crural spastic paraparesis and back pain. Radiological examinations showed multilocular lesions involving compression of the thoracic spine and rib injury. The patient underwent vertebrectomy with spinal stabilization and thoracoplasty with resectioning of the costal arch. Subsequently, the patient was prescribed oral treatment with albendazole. Marked recovery of the neurological status was achieved. Bone hydatid disease is rare, accounting for 0.5%-0.4% of all hydatid cysts, affecting the spine in 50% of cases. The treatment of choice is surgery accompanied by antiparasitic medication.

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Cystic echinococcosis (CE) is a major neglected tropical zoonotic disease caused by the tissue-dwelling larval stage of the cestode parasite Echinococcus granulosus. For individuals suspected of CE, the diagnostic standard is imaging using ultrasonography, X rays, or computed tomography. These resource-demanding and expensive procedures are rarely available in endemic rural areas where CE is most prevalent. There is a critical need for a new approach to identify CE patients so that they can be managed early in the course of their infection. This study reports on the results of a diagnostic approach that identifies E. granulosus-derived cell-free DNA (cfDNA) in the urine of CE patients. Utilizing PCR to amplify a fragment of a major tandem repeat element found in E. granulosus nuclear DNA, urine samples from all seven imaging-confirmed CE patients who harbored active liver cysts were positive. In addition, the urine samples from 2/4 patients who presented with non-viable/calcified liver cysts were also PCR positive for the repeat fragment. To our knowledge, this is the first report of using parasite cfDNA from urine to diagnose CE. This approach provides an easy to implement and cost-effective method to survey for the prevalence of E. granulosus in humans populations.

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RESUMEN La hidatidosis es una infección zoonótica que puede invadir múltiples órganos en el ser humano. Sin embargo, el tejido subcutáneo es el órgano menos afectado por esta enfermedad, cuando esto ocurre se aprecia escasa sintomatología, lo que ocasiona periodos prolongados de enfermedad asociado a diagnóstico tardío y a una pobre respuesta a la terapia antiparasitaria. La sierra central del Perú es la zona con mayor prevalencia, presumiblemente por las inadecuadas medidas de saneamiento ambiental, la falta de educación y las casi inexistentes medidas de control de la enfermedad. Con el objetivo de discutir los problemas relacionados a la localización subcutánea y su probable fisiopatología, reportamos dos casos de hidatidosis subcutánea que se presentaron con lesiones tumorales de evolución prolongada y que no afectaron al hígado ni a los pulmones y que finalmente fueron tratados mediante extirpación quirúrgica debido a la falta de respuesta al tratamiento con albendazol.

ABSTRACT Hydatidosis is a zoonotic infection that can invade many organs in the human being. Nevertheless, the subcutaneous tissue is the less affected organ by this disease. When this disease appears, little symptomatology is observed, which causes prolonged periods of disease associated to delayed diagnosis and a poor answer to the antiparasitic therapy. The central mountain range of Peru is the geographical zone with the greatest prevalence, presumably due to the inadequate measures of environmental sanitation, the lack of education and the almost non-existent control measures of the disease. With the aim to discuss the problems related to the subcutaneous location and its probable physiopathology, this study reports two cases of subcutaneous hydatidosis that appeared with tumor lesions with a prolonged evolution and that did not affect the liver or the lungs and which were finally treated by means of surgical removal due to the lack of response to treatment with albendazol.

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Background: Species belonging to genus Echinococcus are cestode parasites well known for helminthic infections globally.Diseases caused by these parasites are serious health threats for public and veterinary sectors. DNA-based characterization confirmed genetic variability among Echinococcus species and resulted in the identification of 10 genotypes (G1-10).Among identified Echinococcus species, E. granulosus and E. multilocularis are clinically most important responsiblefor cystic echinococcosis and alveolar echinococcosis, respectively. Identification and genetic characterization of thesecestode parasites at species level is essential for disease diagnosis and control measures. This study aimed at narrowinggap of missing knowledge on Echinococcus spp. and their genotypes in Khyber Pakhtunkhwa (KP), Pakistan.Materials, Methods & Results: Hydatid cysts of human source were obtained under aseptic conditions from thoracic surgery unit of the Lady Reading Hospital (LRH) at Peshawar, KP, Pakistan. Hydatid cysts from animal source (cattle) werecollected at Peshawar visiting numerous abattoirs. Theses cyst samples (n = 40) were collected from animals (cattle) (n= 30) and human sources (n = 10). Nucleic acid was extracted from aspirates obtained from cysts, and investigated usingpolymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of a mitochondrial coding gene(rrnL, large subunit of ribosomal RNA). A pair of primers (ECH-LSU/F and ECH-LSU/R) were used to amplify a 570-bpDNA fragment of a mitochondrial gene (rrnL, large subunit of ribosomal RNA) containing a species-specific SspI restriction site for the differentiation among E. granulosus and E. multilocularis. Overall results indicated that among the cystscollected from animal and human sources, majority were positive for E. granulosus (n = 24, 60%) and E. multilocularis (n= 16, 40%)...(AU)

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Background: Species belonging to genus Echinococcus are cestode parasites well known for helminthic infections globally.Diseases caused by these parasites are serious health threats for public and veterinary sectors. DNA-based characterization confirmed genetic variability among Echinococcus species and resulted in the identification of 10 genotypes (G1-10).Among identified Echinococcus species, E. granulosus and E. multilocularis are clinically most important responsiblefor cystic echinococcosis and alveolar echinococcosis, respectively. Identification and genetic characterization of thesecestode parasites at species level is essential for disease diagnosis and control measures. This study aimed at narrowinggap of missing knowledge on Echinococcus spp. and their genotypes in Khyber Pakhtunkhwa (KP), Pakistan.Materials, Methods & Results: Hydatid cysts of human source were obtained under aseptic conditions from thoracic surgery unit of the Lady Reading Hospital (LRH) at Peshawar, KP, Pakistan. Hydatid cysts from animal source (cattle) werecollected at Peshawar visiting numerous abattoirs. Theses cyst samples (n = 40) were collected from animals (cattle) (n= 30) and human sources (n = 10). Nucleic acid was extracted from aspirates obtained from cysts, and investigated usingpolymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of a mitochondrial coding gene(rrnL, large subunit of ribosomal RNA). A pair of primers (ECH-LSU/F and ECH-LSU/R) were used to amplify a 570-bpDNA fragment of a mitochondrial gene (rrnL, large subunit of ribosomal RNA) containing a species-specific SspI restriction site for the differentiation among E. granulosus and E. multilocularis. Overall results indicated that among the cystscollected from animal and human sources, majority were positive for E. granulosus (n = 24, 60%) and E. multilocularis (n= 16, 40%)...

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Human cystic echinococcosis is a zoonosis caused by the metacestode stage of the tapeworm Echinococcus granulosus. Although benzimidazole compounds such as albendazole and mebendazole have been the cornerstone of chemotherapy for the disease, there is often no complete recovery after treatment. Hence, in searching for novel treatment options, we examined the in vitro efficacies of 5-fluorouracil (5-FU) and paclitaxel (PTX) against E. granulosus germinal cells, protoscoleces and cysts. 5-FU or PTX inhibited the growth of E. granulosus cells in a time dependent manner. Although both treatments had a protoscolicidal effect, 5-FU had a considerably stronger effect than PTX. 5-FU produced a dose- and time-dependent effect, provoking the complete loss of viability after 24 days of incubation. Moreover, cysts did not develop following the inoculation of treated protoscoleces into mice. The loss of viability was slower in PTX treated protoscoleces, reaching to approximately 60% after 30 days. The results of the in vitro treatment with 5-FU and PTX were similar in secondary murine cysts. The employment of SEM and TEM allowed us to examine, at an ultrastructural level, the effects induced by 5-FU and PTX on E. granulosus germinal cells, protoscoleces and murine cysts. In conclusion, the data obtained clearly demonstrated that 5-FU and PTX at clinically achievable concentrations inhibit the survival of larval cells, protoscoleces and metacestodes. In vivo studies to test the antiparasitic activities of 5-FU and PTX are currently being undertaken on the murine model of cystic echinococcosis.

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During a period of 28 months (January 2011-April 2013) periodical visits were made to four cattle slaughter houses to collect samples of lesions found in cattle slaughtered for human consumption. Three hundred and three lesions were collected, 25% of which were caused by six different parasites: The metacestodes of Echinocccus granulosus (hydatid cysts), Fasciola hepatica, the metacestodes of Taenia saginata (Cysticercus bovis), Oesophagostomum radiatum, Eurythrema coelomaticum, and Paramphistomum cervi. Gross and microscopic aspects of the lesions caused by these worms are profusely illustrated and a detailed description of both pathological aspects, gross and microscopic, are provide in the hopes that the neophyte veterinary meat inspector can benefit from them in the task of recognition and interpretation of the significance of these lesion both to human and animal health. In regard to the two latter objectives, the life cycle, and the pathogenicity to the animal and human hosts, and the destination of the affected carcass or organ in the line of inspection are discussed for each parasite.(AU)

Durante um período de 28 meses (janeiro 2011-abril 2013) foram feitas visitas periódicas a quarto abatedouros frigoríficos de bovinos para colher lesões regularmente encontradas em bovinos abatidos para consumo humano. Trezentas e três lesões foram colhidas, 25% das quais eram causadas por seis parasitas diferentes: o metacestoide de Echinocccus granulosus (cisto hidático), Fasciola hepatica, o metacestoide de Taenia saginata (Cysticercus bovis), Oesophagostomum radiatum, Eurythrema coelomaticum e Paramphistomum cervi. Os aspectos macro e microscópicos causados por esses vermes são profusamente ilustrados e uma descrição macro e microscópicadas lesões é fornecida na esperança de auxiliar o inspetor de carnes iniciante na tarefa de reconhecer e interpretar o significado dessas lesões tanto para a saúde animal quanto para a saúde humana. Com respeito a esses últimos objetivos, o ciclo evolutivo, e os efeitos nos hospedeiros animal e humano, e ainda a destinação da carcaça ou órgão afetado na linha de inspeção, são discutidos para cada parasita.(AU)

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During a period of 28 months (January 2011-April 2013) periodical visits were made to four cattle slaughter houses to collect samples of lesions found in cattle slaughtered for human consumption. Three hundred and three lesions were collected, 25% of which were caused by six different parasites: The metacestodes of Echinocccus granulosus (hydatid cysts), Fasciola hepatica, the metacestodes of Taenia saginata (Cysticercus bovis), Oesophagostomum radiatum, Eurythrema coelomaticum, and Paramphistomum cervi. Gross and microscopic aspects of the lesions caused by these worms are profusely illustrated and a detailed description of both pathological aspects, gross and microscopic, are provide in the hopes that the neophyte veterinary meat inspector can benefit from them in the task of recognition and interpretation of the significance of these lesion both to human and animal health. In regard to the two latter objectives, the life cycle, and the pathogenicity to the animal and human hosts, and the destination of the affected carcass or organ in the line of inspection are discussed for each parasite.

Durante um período de 28 meses (janeiro 2011-abril 2013) foram feitas visitas periódicas a quarto abatedouros frigoríficos de bovinos para colher lesões regularmente encontradas em bovinos abatidos para consumo humano. Trezentas e três lesões foram colhidas, 25% das quais eram causadas por seis parasitas diferentes: o metacestoide de Echinocccus granulosus (cisto hidático), Fasciola hepatica, o metacestoide de Taenia saginata (Cysticercus bovis), Oesophagostomum radiatum, Eurythrema coelomaticum e Paramphistomum cervi. Os aspectos macro e microscópicos causados por esses vermes são profusamente ilustrados e uma descrição macro e microscópicadas lesões é fornecida na esperança de auxiliar o inspetor de carnes iniciante na tarefa de reconhecer e interpretar o significado dessas lesões tanto para a saúde animal quanto para a saúde humana. Com respeito a esses últimos objetivos, o ciclo evolutivo, e os efeitos nos hospedeiros animal e humano, e ainda a destinação da carcaça ou órgão afetado na linha de inspeção, são discutidos para cada parasita.

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INTRODUCCIÓN: La hidatidosis es una parasitosis endémica en Chile. Los órganos más frecuentemente afectados son hígado y pulmón. Otras localizaciones, tales como la renal son infrecuentes e implican dificultades diagnósticas. PRESENTACIÓN DEL CASO: Mujer de 25 años, sin antecedentes mórbidos, que consulta por dolor lumbar de un mes de evolución, hematuria autolimitada y distensión abdominal, sin hallazgos patológicos al examen físico En sus estudios de laboratorio realizados en Hospital Base de Puerto Montt, Chile, destaca leucocitosis de 13.500 células/mm3 con eosinofilia relativa de 31,4 por ciento, Velocidad de Eritrosedimentación de 74 mm/h y función renal normal. Se solicita ecotomografía abdominal, en la cual se encuentra un quiste renal izquierdo complejo, hallazgo complementado con Tomografía Axial Computada abdomino-pélvico, la cual confirma quiste renal izquierdo de 13 centímetros de diámetro sin aspecto tumoral y quiste en fosa ilíaca izquierda en posición paravesical e hígado sin lesiones. Adicionalmente se realiza radiografía de tórax, la que resulta de aspecto normal. Se realiza Test para Hidatidosis que resulta positivo. Posteriormente, ante la sospecha de hidatidosis renal, se inicia tratamiento con Albendazol 400 mg al día durante 45 días y posteriormente quistectomía renal, evolucionando de forma satisfactoria. Se decide diferir cirugía de quiste paravesical. DISCUSIÓN: La localización renal de un quiste hidatídico es infrecuente y corresponde a menos del 2 por ciento de los casos, el diagnóstico de un quiste complejo renal debe considerar como diagnóstico diferencial la posibilidad de un quiste hidatídico.

INTRODUCTION: Hydatidosis is an endemic parasitic disease in Chile. The main organs affected are the liver and lungs. Other locations, such as the kidneys, are infrequent and involve diagnostic difficulties. CASE REPORT: A 25 year old woman with no previous history of morbid diseases consulting for a one month evolution of lumbar pain, self-limited hematuria and abdominal distension, with no abnormaities on physical examination. In her laboratory studies there was leukocytosis of 13,500 cells/mm3 with relative eosinophilia of 31.4 percent erythrocyte sedimentation rate (ESR) of 74 mm/h and normal renal function. Abdominal ultrasound found a complex left renal cyst, which was complemented with an abdomen and pelvis computerized axial tomography (CT), which confirmed a 13-centimeter left renal cyst without tumor-like appearance. Additionally, chest x-ray shows normal appearance. Enzyme-linked immunosorbent assay (ELISA) for hydatidosis is performed, which results positive. Subsequently, and based on the renal hydatid disease suspicion, she was treated with Albendazole 400 mg per day for 45 days followed by renal cystectomy, evolving satisfactorily. It was decided to defer paravesical cyst surgery. DISCUSSION: Renal hydatid cysts are rare and correspond to less than 2 percent of all cases. The diagnosis of kidney cyst should consider the hydatid cyst as a differential diagnosis.

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